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Medical Forum / General / Dentistry / November 2007Dentist advising to wait on root canal
I have the opposite problem of many people. My dentist is telling me NOT to get a root canal just yet. I got a deep cavity filled in a lower molar, had a partial crown put on and now get occasional throbbing discomfort (not yet pain). He said that the cavity, while deep, had not reached the pulp yet. However, doesn't the throbbing discomfort suggest a pulp infection? But if the cavity had not reached the pulp yet, how could it get infected? What could the throbbing discomfort be due to after a week, if not infection? So many questions! In any case, the dentist said to try fluoride treatments first. So my main question is, does this kind of situation ever correct itself, or is my dentist just delaying the inevitable root canal? Thanks for any feedback. > I have the opposite problem of many people. My dentist is telling me NOT to > get a root canal just yet. [quoted text clipped - 13 lines] > > Thanks for any feedback. Hi Robert, I think that your dentist is trying to see if the nerve will recover from the work that was done on it, and there is always that possibility that it may if given time. You have to appreciate that your dentist is trying to do you a favor actually since if the symptoms do improve, you will have avoided the root canal. It's like a physician who reattaches your arm after a car accident. He says "It was pretty bad, but let's give it a little time to see if it takes." Then you say after a week "My reattached arm was throbbing occasionally over the last week, but it's not that painful yet. Isn't the physician just delaying the inevitable amputation of the arm?" Although throbbing isn't a good sign, it could be an indication of some inflammation of the nerve that may be reversible especially if it isn't constant. It's like if you stub your thumb with a hammer - it's going to throb a bit. Do you decide to have surgery to remove the nerves in it just because of the occasional throb? A cavity that is close to the nerve but does not enter it still may have allowed enough bacteria into the tooth to affect it. The work itself (cold from air / water, heat from friction, bonding agents, etch, etc) being in such close proximity to the nerve could also irritate it enough to cause a temporary inflammation. Pretend you heat up your thumb with a flame for a few seconds. It's going to be a bit tender and achey, but there is healing potential there for it to settle back down. With teeth, because they are confined in a hard structure, it's harder for them to recover from just a bit of inflammation. Sometimes it's best to give it some time to see if the nerve will survive. If the symptoms worsen to constant pain, severe lingering ache on cold and hot, chewing sensitivity, apical signs of an abscess, then sure get the root canal done. Or if you don't want to wait to see if the nerve settles down, tell the dentist you'd love to have the root canal right now. ;-) Zzzdentist www.dentalminds.com >> I have the opposite problem of many people. My dentist is telling me NOT >> to [quoted text clipped - 59 lines] > Zzzdentist > www.dentalminds.com Thanks for the thoughtful reply. Is there anything I can do to give it a better shot at recovery: chew on it more, chew on it less, apply heat, apply cold, take aspirin, etc etc? > Thanks for the thoughtful reply. Is there anything I can do to give it a > better shot at recovery: chew on it more, chew on it less, apply heat, apply > cold, take aspirin, etc etc? You're welcome. Some of my analogies may be off the wall at times, but I find that they give people a different perspective on a scenario to think about. I would chew on the tooth less, stick to lukewarm foods and liquids, rinse with warm water after brushing with Sensodyne toothpaste, take an anti-inflammatory like Ibuprofen for the pain if you have no contraindications to it, check to make sure the tooth's not high in the bite (have it adjusted if it is high), don't grind at night on it (use an occlusal guard or NTI), and hope it recovers. It may very well be on it's way to turning into an irreversible pulpitis, but you never know, it might recover if given some time. Root canals on molars run around $600-800 CDN. If your dentist is trying to see if you can avoid one by giving it some time to possibly heal, I would think that he's a good guy. That's just money out of his pocket if the tooth settles down. The downside of observing the tooth is that the tooth can get worse in terms of ache, and the dentist can have an ornery patient on his hands if the tooth flares up badly. So you see, it's a mixed bag for the dentist. He hopes that the tooth recovers saving you the root canal, but if the tooth gets worse, he could have an upset patient in pain on his hands. Some may say just do the root canal at the drop of a hat, get the money, avoid the possible flare up, and be the hero. Others are willing to try to be the hero by saving the patient the cost of a procedure that might be avoidable but in doing so possibly risk the patient's disastisfaction if the outcome isn't what was hoped for. Zzzdentist www.dentalminds.com >> Thanks for the thoughtful reply. Is there anything I can do to give it a >> better shot at recovery: chew on it more, chew on it less, apply heat, [quoted text clipped - 30 lines] > Zzzdentist > www.dentalminds.com Interesting. I would have guessed chewing on it more (e.g., with a child's teether) to massage it. Thanks for the tips. No, absolutely, I would not take my dentist to task for being conservative. I don't think he is thinking so much of saving me money as it is not doing a root canal unless it is clear it is needed. In your experience have you ever actually seen this kind of thing heal on its own? Would it be 10% of the time, 5% of the time, 1% of the time, less? Incidentally, what is the reason that the pulp usually cannot easily recover from an infection/inflamation like other parts of the body? I assume it has a blood supply like everything else? Thanks again. Robert > No, absolutely, I would not take my dentist to task for being conservative. > I don't think he is thinking so much of saving me money as it is not doing > a root canal unless it is clear it is needed. That's good. Some people don't quite understand the reasoning behind doing things in a certain way, and the dentist may be partly to blame if he doesn't explain it carefully enough. I don't think he was thinking about the money either, but I thought I would bring it up just as a point to consider. > In your experience have you ever actually seen this kind of thing heal on > its own? Would it be 10% of the time, 5% of the time, 1% of the time, less? Yes, I have seen sensitive teeth settle down after a while. Sometimes it takes weeks. In other cases, the nerve does die and the pain ceases (or gets worse), and because the nerve is dead a root canal is indicated. Every case is different, but I would say that approximately 70-80% settle down while 20-30% go on to require root canal therapy. > Incidentally, what is the reason that the pulp usually cannot easily recover > from an infection/inflamation like other parts of the body? I assume it has > a blood supply like everything else? I'm a little rusty on my dental pulp physiology, but here's what I remember. The nerve is encased inside the tooth so it is confined to a space that does not change in dimension. With inflammation, tissues tend to swell up. Since there is no space for the tissues to swell, I do believe that the nerve almost strangulates itself since the only path of exit is at the root tip where the nerve and blood supply enter. The brain is roughly somewhat similar if you'd like an analogy. It's in the skull, and any swelling of the brain can lead to damage. Here's a random quick link about intracranial pressure: http://www.waiting.com/abouttbiicp.html Bacterial infiltration into the nerve of a tooth tends to lead to irreversible pulpitis and nerve death because of the inefficient immune response to the area through the tiny root tip orifice, subsequent infective products produced such as pus that cannot be eliminated efficiently, and confined inflammation as mentioned previously. There are small canal orifices at the ends of the roots where the nerve's blood supply and lymphatics enter. Because of the limited access into the tooth, the nerve's responses to inflammation and infection are somewhat poor. There's some interesting reading on the subject online, but I could not locate an exact explanation of the dental nerve's poor immune responses. You might fair better with a bit more time searching. Here's a start though: http://books.google.com/books?lr=&q=dental+nerve+inflammatory+response&btnG=Sear ch+Books http://books.google.com/books?lr=&q=physiology+of+the+dental+pulp&spell=1&oi=spell Zzzdentist www.dentalminds.com > I'm a little rusty on my dental pulp physiology, but here's what I > remember. The nerve is encased inside the tooth so it is confined to [quoted text clipped - 3 lines] > path of exit is at the root tip where the nerve and blood supply > enter. Very interesting. Makes sense. So I guess the best shot at trying to "cure" pulpitis is with cold (e.g. child's cold teether), anti-inflamatories and maybe anti-biotics? > Very interesting. Makes sense. So I guess the best shot at trying to "cure" > pulpitis is with cold (e.g. child's cold teether), anti-inflamatories and > maybe anti-biotics? It's possible that antibiotics may help, but helping reduce pulpitis is not an indication for their routine use. I was reading though in one research study that something like in the absence of bacteria, pulpitis did not occur after pulpal exposure. I don't know if cold temperatures would help as it might slow down the tissue's ability to combat infection. It might help during the initial stages of inflammation. I'm not certain. I would say anti- inflammatory medications would be the best bet. Zzzdentist www.dentalminds.com . >> Incidentally, what is the reason that the pulp usually cannot easily >> recover >> from an infection/inflamation like other parts of the body? I assume it >> has >> a blood supply like everything else? Because swelling inside the root tip can squeeze the blood vessels enough to restrict or stop blood flow long enough for the tissues to die. Once the tissues are dead, no more blood flows into the tooth. No way the get white blood cells into the tooth anymore. >I have the opposite problem of many people. My dentist is telling me NOT to > get a root canal just yet. [quoted text clipped - 16 lines] > >Look root canals in archives. That will answer all of your questions. HMO ??? >I have the opposite problem of many people. My dentist is telling me NOT to > get a root canal just yet. [quoted text clipped - 14 lines] > > Thanks for any feedback. No, just a conservative dentist, which I guess I should be thankful for. > HMO ??? > [quoted text clipped - 18 lines] >> >> Thanks for any feedback. > I have the opposite problem of many people. Mydentistis telling me NOT to > get a root canal just yet. [quoted text clipped - 12 lines] > > Thanks for any feedback. My experience tells me your tooth needs root canal therapy. If the tooth is merely sensitive to cold or hot that is a good sign indicating the nerve is still vital (alive). However the throbbing pain you are intermittently having shows the damage to the pulp (nerve) of your tooth is irreversible and needs to be treated ASAP before an acute flare-up. >> I have the opposite problem of many people. Mydentistis telling me NOT to >> get a root canal just yet. [quoted text clipped - 23 lines] > (nerve) of your tooth is irreversible and needs to be treated ASAP > before an acute flare-up. Thanks. I went to an oral surgeon for another opinion. He took x-rays and said the throbbing could be because the crown had to go so close to the nerve. He said to use it normally and to revisit it in a couple of months. He thought that RCT could be required but at this point would be premature. |
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